ABSTRACT
Objective:
To analyze public management actions regarding organ, cell, and tissue transplant procedures and their financial investments in Brazil.
Method:
Mixed (time and place) ecological study, carried out based on data from the Hospital Information System of the Brazilian Public Health System (SUS) Information Technology Department and the National Transplant System, from 2001 to 2023. Temporal trend analyses, descriptive and inferential statistics were performed.
Results:
Organ, cell, and tissue transplants are concentrated in the Southeast region of the country, with increased costs there. The Northeast and South regions of Brazil have the longest waiting list, with an increasing trend (R2 = 0.96), associated with a decreasing trend in the number of transplants (R2 = 0.97).
Conclusion:
The difference in the total number of transplants and procedures performed among the Brazilian regions represents the need for organization and investments with strategies aimed at training professionals and raising awareness among the population.
DESCRIPTORS
Organ Transplantation; Tissue and Organ Procurement; Costs and Cost Analysis; Health Services Accessibility; Epidemiology
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Legend: MA = Moving Average; SO = Solid organs; pmp = Per million population.Note: (A) Moving average and trend curve of the waiting list for solid organs and corneas (R2 = 0.96); the waiting list for solid organs (R2 = 0.94); the cornea waiting list (R2 = 0.91); (B) Moving average and trend curve for the number of solid organ and cornea transplants (R2 = 0.97); the number of solid organ transplants (R2 = 0.94); the number of corneal transplants (R2 = 0.98); (C) Moving average and trend curve of the rate of solid organ transplants per million population (R2 = 0.93); the rate of corneal transplants per million population (R2 = 0.98); (D) Moving average and trend curve of the number of potential donors (R2 = 0.99) and actual donors (R2 = 0.99).
Legend: SO = Solid organs.Note: (A) Difference between the number of effective donors: North and Central-West < Northeast, South and Southeast; Northeast < Southeast (H = 85.807 (gl = 4); p < 0.0011); (B) Difference between the number of potential donors: Central-West and North < All regions; Northeast > Central-West and North; Northeast < Southeast; South > Central-West and North; South < Southeast; Southeast > All regions (F = 100.498 (gl = 4); p < 0.0012); (C) Difference between the number of family interviews carried out: North > South, Northeast and Southeast; Central-West > Southeast (H = 36.745 (gl = 4); p < 0.0011); (D) Difference between the number of family denials: North > Northeast, Southeast; Central-West > Southeast (H = 32.440 (gl = 4); p < 0.0011); (E) Difference between the percentage of completion: Central-West and North < Northeast, South and Southeast; North East > Central-West, North and South; South > Central-West, North and Southeast; Southeast – Central-West and North (F = 17.637 (gl = 4); p < 0.0012); (F) Difference between the percentage of family denial: North > Northeast, Southeast; Central-West > Southeast (H = 32.440 (gl = 4); p < 0.0011); (G) Difference in the cornea waiting list: North > Northeast, South; Southeast > Northeast, South; Central-West > Northeast, South (H = 40.286 (gl = 4); p < 0.0011); (H) Difference in the number of corneal transplants: North > All regions; Central-West > Southeast; Southeast > South, Northeast (H = 85.063 (gl = 4); p < 0.0011); (I) Difference between the number of people on the waiting list for solid organs: North > Southeast, Northeast, South; Central-West > Northeast, Southeast, South; Southeast > South (H = 60.815 (gl = 4); p < 0.0011); (J) Difference between the total number of solid organ transplants: North and Central-West > Northeast, South, Southeast; North East > Southeast (H = 82.616 (gl = 4); p < 0.0011); 1 Kruskal Wallis test with Dunn post-hoc test; One-way Anova test with Welch correction and Games-Howell post-hoc test.
Note: (A) Hospitalizations for collection and examinations for the purpose of donating organs, tissues and cells, and of transplantation: Central-West< South, Northeast and Southeast (p = 0.014; p = 0.002; p < 0.001); Southeast > South (p = 0.003); North East < Southeast (p = 0.018). (B) Hospitalizations for Actions related to the donation of organs and tissues for transplantation: North < Northeast, Southeast and South (p < 0.001); Central-West < South and Southeast (p = 0.005; p < 0.001); Northeast < Southeast (p = 0.024); (C) Hospitalizations for organ, tissue and cell transplantation: North < Northeast, Southeast and South (p < 0.001); Central-West < South and Southeast (p = 0.017; p < 0.001); Northeast < Southeast (p = 0.046); (D) Costs related to collection and exams for organ, tissue and cell donation and for transplantation: Central-West < Southeast, South and Northeast (p < 0.001; p = 0.020; p = 0.006); Southeast > South and Northeast (p = 0.007; p = 0.023); (E) Costs for Actions related to the donation of organs and tissues for transplantation: Southeast > Northeast (p = 0.010); North < Northeast, South, Southeast (p = 0.001; p < 0.001; p < 0.001); Southeast and South > Central-West (p < 0.001; p = 0.001); (F) Costs related to organ, tissue and cell transplantation: Southeast > Northeast (p = 0.016); North < Northeast, South and Southeast (p < 0.001); South and Southeast > Central-West (p = 0.003; p < 0.001); (G) Days of hospitalization for collection and examinations for the purpose of organ, tissue and cell donation and transplantation: Southeast –South and Northeast (p = 0.035; p = 0.001); Central-West – South, Southeast (p < 0.004; P < 0.001). (H) days of hospitalization for actions related to the donation of organs and tissues for transplantation: North < Northeast, South and Southeast (p = 0.013; p < 0.001; P < 0.001); Central-West < South and Southeast (p < 0.001); Northeast < Southeast (p = 0.002); (I) days of hospitalization for organ, tissue and cell transplantation: North < South and Southeast (p < 0.001); Northeast < Southeast (p < 0.001); Kruskal-Wallis test with Dunn Post-Hoc test.